I'm having an issue with PM's, they won't show in my "sent", just "outbox", so I don't think it went through.

Anyway,

I appreciated your posts/expertise in that Spinal Stenosis thread. Being that you are in the industry but have a balanced view of doctors, and that money makes the world go round, I wondered if I could bounce something off of you.

My wife, who is 30 years old, is having back issues. We don't know of a specific injury she had other than this starting about 2 years ago shortly after giving birth. We finally got an MRI approved and it came back as "abnormal". I picked out one image, see here: http://www.girardcup.com/disk-problems.jpg.

In addition, this is what it says on the paper that came with it:

Findings: Levocurvature. Some faint edema of the L4-L5 endplates eccentric to the left. Conus normal in appearance position.

L3-L4: Disc desiccation with annular tear and diffuse disc bulge, posterior portion could reflect a shallow broad protrusion. There is a scalloping of the ventral margin of the thecal sac with mild lateral recess crowding. Foramen clear.

In short, to my uneducated take, this sounds bad. They referred us to a neurosurgeon in our small-ish town of Erie, but when I looked at the MRI findings I preemptively got her an appointment with a highly rated neuro in Pittsburgh (Doctor El-Kadi). http://www.neurosurgery.pitt.edu/person/matt-elkadi

From my research he is good, maybe only strike against him is that he herds his patients in and out too quickly.

I apologize for the length of this, but down to my question: I (and my wife) are petrified of unnecessary surgery. BUT the MRI looks bad enough to me that I'm afraid it will be the only option? I have a hard time trusting doctors enough to tell me the truth on if something is needed or not, because it's a business to an extent. I feel like all we can do is pick the best Doc we can, at least on the surface, and go with what he says, but I want to be armed with as much information as possible.

Any insight you (or anyone else that cares) would have on any of this I would be extremely grateful.

When I was 29 my back was hurting. An xray showed I had a deteriorating disk. I would miss work 6 days a year with back pain. I bought a roman chair. It helped. Through the years I had back pain off and on. Used a Chiro occasionaly. Last December I discovered that routine. It's working.

Sorry I'm just now getting back to you, I'm on vacation and this is the first time that I've checked into the GEA this week. That's why your messages still show up as unsent, because I hadn't seen them. On to your post....

There's a lot going on here, and to be honest, I (nor anyone else) can tell the entire story from just one picture. I don't have the localizer as a reference. What that means is there is essentially a road map of where this slice was taken. For a full understanding or what's going on, the Dr will look at each slice in reference to where it was taken as well as the adjacent segment. And, just as a reminder, I am not a doctor.

You've got a radiologist report that explains the findings pretty well. If there are words that you don't understand then I can help or you can Google them.

It is very normal to question past injuries or what could she have done to prevent this. Try your best to avoid these mental gymnastics. They serve no purpose and honestly, there is no specific injury that I see here. Even if there was, you couldn't change it now. You have to play the cards you are dealt.

What I see is surprising considering your wife's age. Three bad discs at 30 years old is out of the norm. Even to the untrained eye, it's pretty obvious that something is going on here. If you look at the discs at L1-2 and L2-3 (the top two segments), they are normal. You can use them as a reference. They are plump with a white center. That white center shows that the disc is hydrated. Moving down to the next segment L3-4, there is a hint of white, but the disc looks mostly dehydrated to me. There's a slight bulge, but not having a localizer to refer to, I have no idea where this is located. It may or may not be problematic. L4-5 is the one that stands out. It is protruding the most and is likely problematic, but again, without knowing exactly where this is located, it's not automatically the problem. Similarly at L5-S1, but there is more at this level. Notice how the bony endplate above this disc has a concavity? This tells me that this level has been problematic for a while and the bone has tried to remodel itself. That's not unusual by the way.

I just went back and read the radiologist report. It continually says that the neural foramen are clear. This leads me to believe that her major complaint is probably back pain (you never said what her complaint was). If there was foramenal stenosis, she would likely be having numbness or weakness down her legs. Does she? I'd be interested to know.

My suggestion to you? Don't just get the opinion of one surgeon. In fact, I'd find an orthopedic spine surgeon and get his opinion as well. Here's why. Neurosurgeons want to deal with nerves and are generally trained to operate from the back. Orthopedic surgeons are trained to deal with structural problems and are more likely to operate from the front. In her case, I think she has structural defects that are causing much of her problem. Do some research on ALIF or anterior lumbar interbody fusion. I'm not saying that this is the answer to your problems, just that many neurosurgeons were not trained on this procedure and shy away from it. It may sound odd, but the back muscles are sparred and the recovery is much faster.

I feel like I may have wandered around the topic here, so I apologize if I did. Please write back if you have other questions, or if I confused you in any way.

My take home message for you is this. First, she did nothing to cause this, it's just an unfortunate part of being a human. Second, get multiple opinions. She's in not danger of being paralyzed or anything like that. If some Dr says she is, run away from him. Know that she definitely has some surgery in her future. It's not something to be happy about, but know that there are many skilled surgeons who can help her. It will be a life changing event, but it's not a life ending one.

Oh no problem at all - and I know you're not a doctor - I'm just trying to take in as much info as I can, and your response helped a lot.

Her pain is primarily radiating down both legs. When it's bad it's all the way down to her foot. On the positive she doesn't have any "weakness", just what she describes as pulling and tingling. It's something she says she can live with, except for at night it makes sleeping difficult with the constant "pulling" and inability to get comfortable. Ibuprofen helps her a lot but I know it's not ideal to be popping Ibuprofen all the time. We've shopped for better mattresses in case that would help, but every one she lays on, the "pulling" is about the same. After seeing the MRI, it's obviously not anything a different mattress would help.

I will take your advice about a second opinion no matter what El Kadi says (it can't hurt), and I will research ALIF.

I really feel bad for her. We have a 3 year old and it's hard with this kind of pain to chase around a toddler and live a normal life.

In your experience, is this something a steroid epidural would help? That seems to be the next logical step other than surgery, but the downside I've read is that in some cases it can only provide relief for a short time (if it does at all). Also, it's not like it fixes an underlying major problem which may be happening here. :|

An epidural steroid shot will not hurt anything, it may or may not help. I would definitely give it a go. Sometimes the Dr will want to do a series of them, I would suggest you go with whatever he suggests. You might also want to try an inversion table. Again, it may not help but it can't hurt.

Now that you mention the tingling down her legs, the ALIF may not be her best bet; although, I wouldn't rule it out either. However, it is a bit unusual for it to go down both legs at the same time. Radicular symptoms are indicative of foramenal issues, and the radiologist's report says that they are clear. I'm not sure what to make of this.

Not to sound like a broken record, but continue to seek multiple opinions. If you know any nurses, they are usually a great resource for information. Other patients can be a reference point, but be careful because there are SO many different issues and solutions that you cannot compare yours with anyone else's.

Feel free to respond to me here or PM me if you have any other questions.

I have had two steroid injections in my lower back. Neither were particularly painful. There is a slight bee sting type feel when the lidocaine is injected to numb the area. But the actual steroid injection was more of a pressure sensation that quickly passed. I wouldn't want to have one done every day but as those types of things go it wasn't too bad. The anti-inflammatory effect lasted about 3 months with each. After the last wore off I had an ablation procedure done and that has more or less completely relived by lower back pain.

Another surgical sales rep checking in....I couldn't agree more about securing multiple opinions from different specialties, should your problem lend itself to it.

The reality is "when you're a hammer, every problem looks like a nail". Surgeons generally want to operate to fix something. Medical docs want to treat with.....medicine. Neither is necessarily right or wrong, so it's good to get both views.

Another surgical sales rep checking in....I couldn't agree more about securing multiple opinions from different specialties, should your problem lend itself to it.

The reality is "when you're a hammer, every problem looks like a nail". Surgeons generally want to operate to fix something. Medical docs want to treat with.....medicine. Neither is necessarily right or wrong, so it's good to get both views.

So in the case, would your second opinion be with another neurosurgeon or go to an orthopedic surgeon?

I'll defer to geddleman - he knows backs way better than I do. My areas of expertise are ophthalmology and GI. But before I did any back surgery, I'd get at least 2 opinions from different surgeons.

I was speaking more philosophically....different doctor's perspectives are formed by what they are trained to do, and be able to fix. Just like every other human being on the planet. Guys who make golf clubs are more apt to try to fix a golfer's faults with new equipment; a golf pro is more apt to try to fix the same faults with lessons... :) Neither is wrong, necessarily, but the golfer himself needs to do enough research to decide which is the best course of action for him.

The harder issue to discern, in my mind, if you do indeed need surgery - who is actually a good surgeon? Patients tend to go by word of mouth, with most patients swayed greatly by bedside manner, whether they are seen on time, how nice the staff is, whether the doc has a big title at a hospital, whether he's published or on the lecture circuit, etc. I can't tell you how many times a patient has told me how great their surgeon is, and I know the guy has horrible surgical skills. Might be a fantastic guy, I'll dine with him and love the guy, but I wouldn't let him operate on me.

There are a lot of surgeons who are like a golfer who has all the best clubs, takes a ton of lessons, cares a lot, and still can't break 90. Sometimes the skills just aren't there.

I'll defer to geddleman - he knows backs way better than I do. My areas of expertise are ophthalmology and GI. But before I did any back surgery, I'd get at least 2 opinions from different surgeons.

I was speaking more philosophically....different doctor's perspectives are formed by what they are trained to do, and be able to fix. Just like every other human being on the planet. Guys who make golf clubs are more apt to try to fix a golfer's faults with new equipment; a golf pro is more apt to try to fix the same faults with lessons... :) Neither is wrong, necessarily, but the golfer himself needs to do enough research to decide which is the best course of action for him.

The harder issue to discern, in my mind, if you do indeed need surgery - who is actually a good surgeon? Patients tend to go by word of mouth, with most patients swayed greatly by bedside manner, whether they are seen on time, how nice the staff is, whether the doc has a big title at a hospital, whether he's published or on the lecture circuit, etc. I can't tell you how many times a patient has told me how great their surgeon is, and I know the guy has horrible surgical skills. Might be a fantastic guy, I'll dine with him and love the guy, but I wouldn't let him operate on me.

There are a lot of surgeons who are like a golfer who has all the best clubs, takes a ton of lessons, cares a lot, and still can't break 90. Sometimes the skills just aren't there.

I agree, which is a terrifying prospect for a potential surgery patient. You are basically taking your best educated guess as to who to go with.

This doctor we picked for the first opinion for example, El Kadi, his only knock is his bedside manner and not talking enough about the patients concerns. But at the same time he's supposedly a great surgeon, so I would take that all day long. It's all guesswork in the end though. :S